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Recurrence of Prolapse After Transvaginal Mesh Excision

George, Amy MD; Mattingly, Marlena MD; Woodman, Patrick DO; Hale, Douglass MD

Female Pelvic Medicine & Reconstructive Surgery: July/August 2013 - Volume 19 - Issue 4 - p 202–205
doi: 10.1097/SPV.0b013e31829098a5
Original Articles

Objective Recurrence of pelvic organ prolapse (POP) is a potential complication after mesh removal. We evaluated anatomical and functional outcomes preoperatively and postoperatively in patients undergoing mesh excision.

Materials and Methods We conducted a retrospective cohort analysis of consecutive patients who underwent mesh excision from years 2005 to 2009. Anatomical outcomes were evaluated using the POP quantification (POP-Q) system. Recurrence of prolapse was defined as stage II or higher-stage prolapse on the POP-Q system, reoperation for prolapse, or postoperative use of a pessary for prolapse reduction. Functional outcomes were assessed using the pelvic floor distress inventory and pelvic floor impact questionnaire scores.

Results Data were analyzed from 71 patients who underwent either partial or complete mesh excision. Most (44/70 [63%]) of the patients underwent partial mesh excision, and 26 patients (37%) underwent total mesh removal. Nineteen patients (26.7%) had preoperative prolapse and 27 (38.0%) of the 71 patients underwent concomitant native tissue prolapse repair. Overall change in POP-Q stage in women who underwent partial removal (median, 0 [−1 to 2]) was less advanced than in women with total excision. (median, −1 [−3 to 0]; P = 0.006) at 1 year postoperatively. Four patients prolapsed to the hymen, with all patients having defects in the anterior compartment. No patients required a second surgery, and one patient was treated with a pessary.

Total pelvic floor distress inventory and pelvic floor impact questionnaire scores before mesh excision were significantly improved 6 months after mesh removal (P < 0.05). Dyspareunia improved significantly after mesh excision (P = 0.034).

Conclusion In our patient population, total and partial mesh excision is associated with re-treatment of POP in 1.4% of the patients. Patient functional outcomes significantly improved after mesh removal.

Risk of recurrent prolapse is low following total and/or partial mesh excision.

From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Indiana University Health, Indianapolis, IN.

Reprints: Amy George, MD, Indiana University/Methodist Hospital, Indianapolis, IN. E-mail: amygeor@iupui.edu.

The authors have declared they have no conflicts of interest.

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.